Provider Demographics
NPI:1043958051
Name:DOLLAR, NICOLE ALLENE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ALLENE
Last Name:DOLLAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3938 NAVY HILL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-8356
Mailing Address - Country:US
Mailing Address - Phone:614-599-7681
Mailing Address - Fax:
Practice Address - Street 1:150 E WILSON BRIDGE RD STE 250
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2397
Practice Address - Country:US
Practice Address - Phone:740-348-6016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0439155Medicaid